Claims Specialist

• Review Claims Documentation: Examine photos, estimates, reports, contracts and other documentation submitted by policyholders, contractors, or field adjusters to assess damage and determine the extent of loss.
• Assess Property Damage: Analyze claims for accuracy and determine the cause of damage, ensuring compliance with policy terms and conditions.
• Estimate Costs: Collaborate with vendors to estimate repair or replacement costs based on the damage reported.
• Process Claims: Manage claims through the full lifecycle, from initial report to settlement, ensuring all required documentation is collected and all deadlines are met.
• Negotiate Settlements: Communicate with policyholders, contractors, and service providers to negotiate fair settlements.
• Provide Customer Service: Act as a primary point of contact for policyholders, responding to questions, clarifying policy coverage, and resolving issues related to claims.
• Maintain Detailed Records: Document all communications, decisions, and actions taken throughout the claims process to ensure accurate claim files.
• Ensure Compliance: Follow company procedures, legal requirements, and industry regulations when processing claims, ensuring that all actions taken are in line with regulatory standards.

Property Claims Adjuster

• Investigate and handle automobile claims from initial report through resolution.
• Evaluate coverage, determine liability, and assess damages.
• Negotiate claims and guide customers through the claims process.
• Identify potential subrogation or fraud and partner with internal teams.

Auto Telephone Claims Adjuster

• Analyze mid- and higher-level workers compensation claims to determine benefits due
• Ensure ongoing adjudication of claims within company standards and industry best practices
• Identify subrogation of claims and negotiate settlements
• Manage workers compensation claims determining compensability and benefits due on long term indemnity claims
• Approve and process assigned claims and determine benefits due

Workers Compensation Claims Adjuster

• Handling complex claims with a focus on providing exceptional service for stakeholders
• Communicating with policyholders, agents, attorneys, and witnesses to gather information
• Investigating claims to determine exposure and making strategic recommendations
• Utilizing appropriate resolution tactics to drive outstanding results
• Collaborating with team members from various departments for project and process discussions
• Preparing and presenting claims status reports for internal and external stakeholders

Claims Specialist – Workers' Compensation

• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

Liability Claims Adjuster – General Liability, Bodily Injury, Property Damage

• Responsible for providing claims technical consultation and training to claims personnel on casualty claims for the Agribusiness (AG) Operations.
• Assists in analyzing the exposure of cases, including consideration of all pertinent information.
• Provides analysis and feedback on case status to Claims Leadership.
• Ensures defense counsel is timely and properly providing aggressive litigation on behalf of Zenith insureds.
• Participates in file conferences and makes recommendations for future handling action plans.
• Prepares case updates analyzing exposures and providing recommendations.
• Assists in ensuring that detailed action plans are formulated and completed in a timely manner.

Regional Claims Analyst

• Review and analyze incoming workers' compensation claims to determine severity and benefits owed
• Communicate with injured workers, employers, medical providers, and internal teams
• Document claim details and triage decisions in the claims management system
• Identify potential fraud indicators and escalate as needed
• Maintain compliance with company policies and state regulatory requirements
• Support continuous improvement initiatives within the triage process

Claims Associate

• Manage complex vendor relationships and monitor performance
• Provide coaching and mentoring to staff
• Oversee specialized claims and documentation
• Participate in performance reviews
• Conduct file examinations and calibration with vendors

Claims Adjuster – Team Lead

• Make initial contacts with interest parties
• Handle moderate to high exposure construction defect claims involving residential and commercial projects.
• Analyze coverage and draft coverage position letters as needed
• Conduct liability investigations
• Comply with DOI regulations
• Retain and coordinate with defense counsel and experts to develop and execute agreed-upon litigation strategies, while managing plans and budgets to ensure effective case resolution
• Coordinate the retention of experts, subject to an agreed upon budget
• Establish timely indemnity and expense reserves based on an exposure analysis that is documented in the claim file, revisiting reserve adequacy on a continual basis
• Draft well written and comprehensive captioned reports to request reserve and settlement authority on higher exposure cases that outline all critical aspects of the case in preparation for roundtable presentations to the carrier partners
• Travel up to 10% to attend mediations, settlements conferences and trials on appropriate cases
• Keep current on key changes in case law and industry trends
• Assist underwriting and other business partners

Senior Casualty Claims Examiner – Construction

• Investigate, analyze, and determine the extent of insurance provider's liability concerning personal, casualty, or property loss or damages, and attempt to effect settlement with claimants
• Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information
• Calculate benefit payments and approve payment of claims within a certain monetary limit
• Investigate claims: Assess and estimate vehicle damage
• Assist with business or managerial research
• Compile information through interviews
• Evaluate customer records
• Examine evidence to determine if it will support claims
• Follow contract, property, or insurance laws
• Follow rules of evidence procedures in legal setting
• Gather physical evidence
• Inspect property to determine damages
• Research property records
• Search legal records
• Interviews, telephones, and or corresponds with claimant and witnesses
• Evaluate liability exposure: Review insurance applications
• Review insurance policies to determine appropriate coverage
• Obtain, review and evaluate records, police, medical, etc.
• Recommend claim action
• Properly reserve for the claim. Adjust reserve as appropriate
• Comply with accepted guidelines regarding reserving practice and authority levels
• Create and maintain records Maintain records, reports, and files which are primarily found on the SIMS and/or Renaissance system
• Maintain all cases on an active diary on the SIMS and/or Renaissance system pursuant to established Company criteria
• Prepare timely reports to clients. Comply with all reporting requirements/steps set out in the GHC Procedure Manual
• Comply with regulatory requirements
• Diary spoken or written information
• Litigation management support: Collect evidence to support contested claims in court
• Keep clients advised
• Other duties as assigned

General Liability and Auto Claims Adjuster II

• Successfully completes classroom training introducing workers compensation claims handling strategies, medical terminology, statutory requirements, and investigative skills.
• Conducts initial investigation of reported claims to determine coverage, compensability, severity, and gather all other relevant information via three-point contact telephone calls.
• Calculates appropriate reserves for each claim and ensures that reserves are adjusted as needed per authority guidelines.
• Develops and updates a Plan of Action for the successful resolution of each claim.
• Makes prompt, sound decisions on issues that arise based on the best information available, ensuring that work is performed in accordance with Company guidelines and applicable statutory requirements. Timely escalates issues/red flags to Supervisor.
• Ensures benefits due injured worker are calculated and issued appropriately in accordance with legal requirements including the issuance of appropriate notices and filings.
• Fosters a positive and close working relationship with internal and external partners, including Call Center, Medical Management, Special Investigations, and Indemnity Adjusting Staff.

Claims Adjuster – Trainee

• Manages a large inventory of highly complex claims to evaluate compensability/liability
• Strategically orchestrates and leads comprehensive claims investigations to confirm coverage and to determine liability, compensability and damages
• Analyzes and negotiates appropriate claim settlements/reserves within prescribed authority
• Conveys highly complex information regarding coverage and settlements to insureds, claimants, and external partners
• Authorizes payments in accordance with assigned authority limit, ensuring timely disbursement
• Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements
• May have responsibility for performance and coaching of staff and may have a participatory role in decisions regarding talent selection, development, and performance management for direct reports

Senior Workers Comp Claims Specialist

• Investigating losses
• Analyzing coverage, determining compensability and benefits
• Establishing reserves and negotiating settlements
• Conducting face-to-face meetings with claimants and insureds
• Preparing large loss reports to both internal and external audiences
• Attending settlement conferences, pre-trials and trials as assigned
• Working closely with defense attorneys and other vendors including medical case management, surveillance, etc.

Field Claims Specialist, Workers' Compensation

• Manages a large inventory of highly complex claims to evaluate compensability/liability
• Strategically orchestrates and leads comprehensive claims investigations
• Analyzes and negotiates appropriate claim settlements/reserves
• May attend arbitrations, mediations, depositions, or trials
• Conveys highly complex information regarding coverage and settlements to insureds, claimants, and external partners
• Authorizes payments in accordance with assigned authority limit
• Maintains accurate and detailed claim files
• May have responsibility for performance and coaching of staff

• Manage a caseload of California workers’ compensation claims from initial assignment through final resolution
• Review and evaluate coverage, liability, and compensability in accordance with California Labor Code and regulatory requirements
• Conduct thorough investigations, including gathering statements, reviewing reports, and analyzing claim documentation
• Set and manage reserves based on exposure and claim developments
• Ensure timely and accurate benefit payments and required communications
• Maintain claim diaries and ensure consistent follow up throughout the life of the claim
• Coordinate return to work efforts and monitor ongoing claim activity
• Oversee litigation, including working with defense counsel and participating in claim strategy discussions
• Negotiate settlements within authority and provide recommendations on cases exceeding authority
• Identify potential fraud, subrogation, and cost containment opportunities
• Maintain accurate and compliant documentation within the claims system
• Communicate effectively with injured workers, employers, medical providers, attorneys, and internal stakeholders

Workers Compensation Claims Examiner

• Attendance and completion of designated claims professional training program.
• Adjusting various levels of workers’ compensation claims under close supervision.
• Communicating effectively with injured workers, insureds/employers, medical providers, attorneys and carrier representatives.
• Thoroughly investigating new and existing claims by gathering relevant information.
• Determining coverage, compensability and appropriate benefits in accordance with jurisdictional guidelines.
• Documenting claims files and properly coding claim activity.
• Preparing detailed reports documenting findings and recommendations.
• Administering claim benefits through maintenance of calendared claim-related action items.

Claims Representative – Workers Compensation Training Program

• Handles moderate to complex claims with a focus on providing high service levels for policyholders
• Manages all aspects of a claims inventory and communicates effectively with stakeholders
• Investigates claims to determine exposure and makes strategic recommendations
• Utilizes resolution tactics to drive outstanding results
• Operates within regulatory rules and internal policies
• Directs defense counsel throughout the litigation process
• Prepares and presents claims status reports for stakeholders
• Administers timely benefits to injured workers
• Resolves claims fairly and equitably acting in the insured’s interest
• Identifies and drives resolution opportunities on complex or long-duration claims

Senior Claims Examiner, Workers’ Compensation

• Manages complex claims inventories requiring advanced technical expertise and strategic claim handling
• Effectively communicates with policyholders, agents, attorneys, and witnesses to gather information and provide highest possible level of customer service
• Promptly investigates claims to determine exposure, works with appropriate experts and makes strategic recommendations
• Utilizes appropriate resolution tactics (e.g., mediation, negotiation, denial, litigation or offer) to proactively drive outstanding results
• Operates within the requirements of related state and/or the governing entity rules and regulations as well as internal claims handling policies and procedures
• Ensures accuracy of data in claims system for compliance with applicable regulatory reporting
• Provides knowledge transfer across the organization
• Continuously seeks to improve technical skills by attending job related training and tracking current case law

Claims Specialist – Contribution

Senior Casualty Claims Examiner

• To analyze Workers Compensation claims on behalf of our valued clients to determine benefits due.
• Ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution.
• Investigating and gathering information to determine the exposure on the claim.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

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Workers Compensation Claims Adjuster

Claims Specialist – Workers' Compensation

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Claims Associate

Claims Adjuster – Team Lead

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General Liability and Auto Claims Adjuster II

Claims Adjuster – Trainee

Senior Workers Comp Claims Specialist

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Senior Workers Comp Claims Specialist

Workers Compensation Claims Examiner

Claims Representative – Workers Compensation Training Program

Senior Claims Examiner, Workers’ Compensation

Claims Specialist – Contribution

Senior Casualty Claims Examiner

Claims Examiner – Workers Compensation